Whenever anyone talks about changing our healthcare system, the opposition warns of healthcare rationing. Here's the thing. Healthcare already is rationed, in truly haphazard ways.
I am among the most fortunate of Americans in that I am well-insured and quite knowledgeable about healthcare coverage from previous work experience. I consider myself to be a sophisticated consumer of our healthcare system. This was very helpful assisting my parents with multiple catastrophic hospitalizations, managing the pandemic, and managing my own medical issues (I happen to be a disabled veteran).
I've been on quite a journey to get an RSV shot. (Note: I get vaccinated. I respect everyone's choice to get vaccinated, or not. It's time to put this issue past us. Please do not email me with long explanations why vaccines are fake science. I will not respond.). Since I have asthma, I asked my primary care physician if I should have it. She suggested I bring the question to my pulmonologist along with one about the latest pneumonia vaccine.
I saw my pulmonologist just before Christmas. I presented him with a conundrum with my question about the RSV vaccine. I am under 60 and not pregnant, so the CDC says I don't need it. My pulmonologist thought otherwise. He could prescribe it, though it wasn't clear if insurance would cover it. And he couldn't give it to me. It's only available in this state through a pharmacy. His office did have the 2023 pneumonia vaccine, so I got topped up with the latest dose on the spot.
I made an appointment online at Walgreens to get the RSV shot right after the New Year. The morning of the appointment, I got a call telling me I couldn't get the shot because I didn't meet the age or pregnancy requirements. I decided to go to the appointment proudly bearing my prescription.
I arrived and spoke to the nice person who had called me (pharmacy technicians are amazing: consummate customer service professionals and at the same time experts in every type of insurance coverage all the while maintaining a log of everyone who buys Sudafed in case they are really making meth and doing all this while the public coughs on them) and showed my prescription. She explained that the CDC had decided I couldn't have it, despite my doctor's preference that I do.
Walgreen's policy was that they would not administer the vaccine outside the CDC guidelines, which, to repeat, are only for people over 60 and pregnant women (hint: this is rationing). I'm 53 with a hysterectomy. I asked again why my physician's order wasn't sufficient. The pharmacist came up with a solution: the state allows the vaccine to be dispensed and the doctor's office to administer it. So I took my vaccine (which neither my primary nor secondary insurance would cover), and put it in my fridge while I called my pulmonologist's office.
Imagine my surprise when the front desk representative got back to me after talking with the nurse and said, "We can't give it to you either." "But you prescribed it!" "Call your primary care provider."
As of this writing, I am waiting to hear back from my primary care doctor. At this point, I am about four hours of effort to get a vaccination prescribed for me by my pulmonologist for the prevention of a pulmonary virus due to a pre-existing pulmonary condition. The pharmacy can only dispense it, but not administer it, due to a policy. The prescriber who ordered it cannot administer it and I am not sure why.
All I know is my insurer bravely avoided covering it and I have $300 of serum in my fridge. Perhaps I should pour it into my bourbon tonight and hope for the best.
Healthcare reform naysayers point to soulless boards that will decide who gets care and who doesn't. That step is completely unnecessary. Our current healthcare system is a quagmire of government policy and insurers' self-interest that eliminates the need for case-by-case decision-making. It's simply impenetrable for most who lack the knowledge, patience, resources, or all of the above, to try and break through.
Merritt Hamilton Allen is a PR executive and former Navy officer. She appeared regularly as a panelist on NM PBS and is a frequent guest on News Radio KKOB. A Republican, she lives amicably with her Democratic husband north of I-40 where they run one head of dog, and two of cat. She can be reached at news.ind.merritt@gmail.com.